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NM PERMIT APPLIC,TiOO <br /> rj <br /> BUILDING / MECHANICAL/ PLUMBING (SIGN / SPRINKLER I DEMOLITION <br /> E V E R E T TCITY OF EVERETT PERMIT S CES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ( 1 l ( 9 ( I r U GV..e $ C= 6152"PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ` Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: L T .,-"-t TENANT BUSINESS NAME(Commercial): 11 7P/4,S J•cc J <br /> OWNER MAILING ADDRESS: STREET t-4.1 'I [/4-4- ,N/2. 13 l o -L <br /> CITY .V,Q,/r 1,- ' l C_ STATE w A-- ZIP y /---{1 <br /> OWNER PHONE: t- - - 273 Z" 31 3OWNER EMAIL: ( \ ( ; 2 )1 r IA 7 7 0 gym l'-' L 6 (`'I- . <br /> CONTRACTOR NAME: (,j1,, t...__ (-;-7-5-ri-5 (J9 <br /> CONTRACTOR ADDRESS: STREET -c---1 ( ( (w�( 1 t <br /> CITY LW)/]w 4 STATE IN / ZIP f <br /> l. CP*) <br /> CONTRACTOR PHONE: (.f-Z4--7(( 5--- 076 -0 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): J/✓t11 7 E i-i 2 )7 1, L) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 S—t/ ' Ci-- <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42, - 7(t,S---- J 7 6�-) <br /> 4ePooe•/ CONTACT EMAIL: E,fiti rt•e. &) (N Imo(,;1-e 5 O-vl $ 1 'a <br /> • BUILDING INFORMATION / G <br /> Existing Use of Building: Contract Price of Work:$ 4-, <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 4 edil 2— -Ito 5 ( ),,I,..-Q--t ) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ' MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) _ Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilation Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential)_ Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads , <br /> Chemical Suppression System No.of Heads. <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18. CW and 296.200A WAC. <br /> City <br /> gty of Everett Official Use Only <br /> '+ q2' 1/( PERM 1 l�C <br /> v -CCD._ <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) <br /> 423 <br />